The government has pledged to move hundreds of people with learning difficulties out of hospitals and into new homes in the community in the wake of the Winterbourne View abuse scandal.
It has also promised that companies that provide services to people with learning difficulties would be held accountable – possibly through the criminal courts – for abuse that takes place in their facilities.
Norman Lamb, the Liberal Democrat care services minister, said he wanted to send “a clear message to owners, directors and board members” that they should “expect to be held to account if abuse or neglect takes place”.
His pledge came as the Department of Health published its final report into the abuse that took place at Winterbourne View, near Bristol.
The report says there will also be efforts to improve access to advocacy, tougher inspections of hospitals and care homes for people with learning difficulties by the Care Quality Commission (CQC), and new guidance on the use of physical “restraint” by staff, which it says should only be used “as a last resort”.
And there will be a national audit of people with learning difficulties and challenging behaviour or mental health conditions, to see how many are in inappropriate, “out-of-area” placements in hospitals, many miles from their own home areas.
The government said that every one of the 3,400 people currently in NHS-funded inpatient beds for people with learning difficulties would have their placements reviewed by 1 June 2013, with all those “inappropriately” in hospital moved to community-based settings no later than 1 June 2014, with between £2 and £5 million from DH to support this improvement programme.
Many campaigners, including Disability News Service, have pointed out that successive governments have made similar pledges on emptying long-stay hospitals over the last 50 years.
But Lamb said it was a “national imperative” that people with learning difficulties who also have mental health conditions or challenging behaviour are “given the support and care they need in the community, near to family and friends”, rather than in hospitals.
The report says that, of the 48 patients living at Winterbourne View at the time it was closed, 14 had been referred by commissioners between 40 and 120 miles away from the hospital, with a further nine by commissioners more than 120 miles away.
Lamb also spoke of his “shock, anger, dismay and deep regret” at the abuse that took place at Winterbourne View, which was only halted after the BBC screened footage filmed by an undercover reporter.
Six former employees were given prison terms ranging from six months to two years for their part in the abuse, but there was widespread anger that Castlebeck, the company that made huge profits from Winterbourne View, was not held accountable for its failings in court.
The report concludes that chances to spot “real problems” at Winterbourne View were “repeatedly missed” by managers, and agencies such as the Care Quality Commission (CQC), the police, the local hospital, local authorities and health trusts.
Andrew Lee, director of People First Self Advocacy, said he believed the “acid test” of the government’s report would be whether its recommendations were acted on.
He pointed out that similar reports had followed investigations into the abuse of patients with learning difficulties at Budock Hospital in Cornwall, in 2006, and at Orchard Hill, another of the last NHS long-stay hospitals, in 2007.
Gavin Harding, co-chair of the National Forum of People with Learning Difficulties, said he was concerned there might not be enough funding to put the government’s plans into action.
He said: “It is all right saying close everything by 2014, but where is the budget going to come from? That worries me.”
A DH spokesman said: “Hospital inpatient placements are very expensive. We think that in many cases it is possible to provide better services locally which meet the needs of people with learning disabilities better for the same amount of money and sometimes less.
“We are committing money to the joint improvement programme to spread best practice and provide advice to local areas on how to design services to meet the needs of people with learning disabilities.”
Alongside the report, more than 50 organisations, including the National Forum, the Local Government Association, the Association of Chief Police Officers, professional social work and health bodies, CQC, and organisations representing service-providers, signed an agreement with the government that they would push to “transform health and care services” for people with learning difficulties and mental health conditions or challenging behaviour.
13 December 2012